Faculty Collaboration Database

The relationship between defibrillation threshold and total mortality. J Interv Card Electrophysiol 2013 Dec;38(3):203-8

Date

10/23/2013

Pubmed ID

24146190

DOI

10.1007/s10840-013-9831-5

Scopus ID

2-s2.0-84889083289 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

BACKGROUND: The relationship between the defibrillation threshold (DFT) and total mortality is unclear.

METHODS: A university hospital prospectively maintained implantable defibrillator (ICD) database identified 508 patients who underwent ICD implantation and had DFT testing performed at implant. Patients were placed in one of three groups based on the implant DFT (high (≥20 J), moderate (19-11 J), or low DFT (≤10 J)).

RESULTS: Sixty-seven patients had a high DFT, 216 had a moderate DFT, and 225 had a low DFT. The mean left ventricular ejection fraction (LVEF) was 0.25, 0.28, and 0.30 in the high, moderate, and low DFT groups, respectively, (p = 0.04). There were significantly more patients with a subcutaneous electrode in the high DFT group (p < 0.001), more patients taking amiodarone (p < 0.001), and more patients on oral anticoagulation (p = 0.04). There were a total of 140 deaths during the follow-up period (mean 3.2 ± 1.7 years). There were 24 deaths in the high DFT group (35.8%), 62 in the moderate DFT group (28.7%), and 54 in the low DFT group (24.0%) (p = 0.05). Implant DFT was a significant predictor of mortality (p = 0.01), as was age, LVEF (p < 0.001), CAD (p = 0.01), amiodarone use (p = 0.02), and hematoma at implant (p = 0.01). An elevated DFT was an independent predictor of mortality after controlling for all significant univariate variables (p = 0.004).

CONCLUSIONS: A high-implant DFT predicts an adverse prognosis, even when an adequate ICD safety margin is present.

Author List

Rubenstein JC, Kim MH, Morady F, Strickberger SA

Author

Jason C. Rubenstein MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cause of Death
Death, Sudden, Cardiac
Defibrillators, Implantable
Differential Threshold
Equipment Failure Analysis
Female
Humans
Incidence
Longitudinal Studies
Male
Middle Aged
Retrospective Studies
Risk Factors
Survival Rate
Treatment Outcome
Wisconsin